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Short- and Long-term Effects of Transscleral Conductive Heating in Rabbit Eyes

Alex I. Rem, MSc; Jendo A. Oosterhuis, MD, PhD; Hanneke G. Journée-de Korver, PhD; Didi de Wolff-Rouendaal, MD, PhD; Jan E. E. Keunen, MD, PhD

Arch Ophthalmol. 2003;121:510-516.

Objective  To determine the highest safe treatment temperature, at 30- and 60-second exposure durations, for transscleral thermotherapy (TSTT) of choroidal melanoma.

Methods and Design  Transscleral conductive heating was performed in 15 rabbits at 50°C to 70°C for 30 or 60 seconds. The thermal lesions in the ocular fundus were monitored for 4 months with ophthalmoscopic, photographic, and fluorescein angiographic examination. Histologic examination included polarized light microscopy.

Results  The effect of TSTT was similar for both exposure durations. Vascular occlusion in the retina and choroid developed at temperatures of 55°C and higher. After heating at 60°C, scleral collagen fibers developed a minimal undulation; at 65°C, they became clearly undulated. The undulation resolved in the 3 to 4 months after heating. Heating at 70°C caused persistent severe damage to the sclera. Retinal tears developed after heating at 65°C and 70°C.

Conclusions  A temperature of 65°C was found to be the highest temperature that did not cause permanent damage to the sclera at both exposure durations. A temperature of 60°C may be the optimal temperature for TSTT of choroidal melanoma because retinal tears may develop at 65°C.

Clinical Relevance  In TSTT, the temperature levels reached are cytotoxic for choroidal melanoma as well as intrascleral tumor cells. Occlusion of choroidal vessels induced by TSTT may contribute to tumor necrosis because these vessels serve as feeder vessels for the tumor.

From the Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands (Drs Oosterhuis, Journée-de Korver, Wolff-Rouendaal, and Keunen and Mr Rem), and Netherlands Ophthalmic Research Institute, Amsterdam (Mr Rem). The authors have no relevant financial interest in this article.